Dynamic CT features of hepatic abscesses

Forty hepatic abscesses were examined with dynamic computed tomography (CT). A "double target sign," consisting of a hypodense central area surrounded by first a hyperdense ring and then a hypodense zone, seems to be highly suggestive of abscess formation. In 12 cases, the hepatic parenchyma surrounding the lesion demonstrated transient hyperdensity after contrast injection, possibly due to localized hepatic venous obstruction secondary to acute hepatic inflammation. This is similar to the appearance of an arterioportal fistula.     

Mitochondrial dysfunction in antiphospholipid syndrome: implications in the pathogenesis of the disease and effects of coenzyme Q(10) treatment

The exact mechanisms underlying the role of oxidative stress in the pathogenesis and the prothrombotic or proinflammatory status of antiphospholipid syndrome (APS) remain unknown. Here, we investigate the role of oxidative stress and mitochondrial dysfunction in the proatherothrombotic status of APS patients induced by IgG-antiphospholipid antibodies and the beneficial effects of supplementing cells with coenzyme Q(10) (CoQ(10)). A significant increase in relevant prothrombotic and inflammatory parameters in 43 APS patients was found compared with 38 healthy donors. Increased peroxide production, nuclear abundance of Nrf2, antioxidant enzymatic activity, decreased intracellular glutathione, and altered mitochondrial membrane potential were found in monocytes and neutrophils from APS patients. Accelerated atherosclerosis in APS patients was found associated with their inflammatory or oxidative status. CoQ(10) preincubation of healthy monocytes before IgG-antiphospholipid antibody treatment decreased oxidative stress, the percentage of cells with altered mitochondrial membrane potential, and the induced expression of tissue factor, VEGF, and Flt1. In addition, CoQ(10) significantly improved the ultrastructural preservation of mitochondria and prevented IgG-APS-induced fission mediated by Drp-1 and Fis-1 proteins. In conclusion, the oxidative perturbation in APS patient leukocytes, which is directly related to an inflammatory and pro-atherothrombotic status, relies on alterations in mitochondrial dynamics and metabolism that may be prevented, reverted, or both by treatment with CoQ(10).     

Impact of preoperative immunonutrition on morbidity following cystectomy for bladder cancer: a case–control pilot study

Purpose

To compare postoperative complications in patients with or without preoperative immunonutrition before cystectomy.

Methods

A prospective, multicenter, pilot, case–control study was conducted during 6 months. Patients with 7-day preoperative immunonutrition were prospectively included and compared with a retrospective, matched control group without immunonutrition. Early complication rates and the length of hospital stay were analyzed. The bilateral type I error was <0.05; the power was 90 %. Thirty patients in each group were required.

Results

Thirty patients were included in each group, on a comparable basis. In the immunonutrition group, fewer postoperative complications (40 vs. 76.7 %; p = 0.008), less paralytic ileus at D7 (6.6 vs. 33.3 %; p = 0.02), fewer infections (23.3 vs. 60 %; p = 0.008), and in particular less pyelonephritis (16.7 vs. 46.7 %; p = 0.03) occurred. Clavien’s grades for complications were higher in the control group (p = 0.04). Mortality, pulmonary embolism, anastomotic fistulae, and wound dehiscence were similar between two groups. The length of stay was reduced by 3 days in the immunonutrition group.

Conclusions

In this pilot case–control study, immunonutrition is associated with a decrease in postoperative complications, urinary tract infections, Clavien’s grade for complications, and paralytic ileus in patients undergoing cystectomy for bladder cancer. Prospective randomized placebo control studies are needed to confirm these promising results.     

Situation,challenges, and SEOM recommendations for the future of undergraduate education in Oncology in Spain

Clinical and Translational Oncology - The Spanish Society of Medical Oncology (SEOM, for its Spanish acronym) would like to attest to the relevance of training in Oncology as part of the...     

Piezoelectric extracorporeal shockwave lithotripsy of distal ureteric calculi: assessment of shockwave focusing with unenhanced spiral computed tomography

OBJECTIVE: To assess the effects of the interposition of pelvic bones and abdominal gas in the shockwave pathway during piezoelectric extracorporeal shock wave lithotripsy (ESWL) of distal ureteric stones. PATIENTS AND METHODS: The study included 35 patients who were evaluated with unenhanced spiral computed tomography (CT), used according to their positioning during ESWL. The shockwave pathway was simulated on the sagittal and coronal views crossing the ureteric calculi, allowing a theoretical evaluation of the effective shockwave focusing (with no bone or gas interference). Vertical and oblique approaches were statistically compared for bone and gas interposition. RESULTS: Overall, the effective shockwave focusing during in situ piezoelectric ESWL of distal ureteric stones was 71% of the theoretical area. The interposition of bone and gas was significantly lower for an oblique access than for a vertical approach in the sagittal plane (P < 0.001 and 0.03 on the sagittal and coronal views, respectively). Using stepwise logistic regression, the difference between vertical and oblique accesses in the sagittal plane was mainly affected by the bladder volume (P < 0.001). On the coronal views, the interposition of bone and gas affected 31 patients (89%). Such interference was eliminated in 73% of the patients with a contralateral inclination of the shockwave axis in the coronal plane. CONCLUSION: The interposition of pelvic bones and abdominal gas in the shockwave pathway can affect the performance of piezoelectric ESWL of distal ureteric stones. While awaiting clinical confirmation of these theoretical data, we recommend that patients are treated with the bladder full and that the shockwave generator is inclined in both the coronal and sagittal planes.     

The word frequency effect for open- and closed-class items

A previous attempt (Segui, Mehler, Frauenfelder,&Morton, 1982) to assess in French the putative computational asymmetry between open- and closed-class words failed to reveal a difference in frequency sensitivity for these two types of words. In the present paper, two further lexical decision experiments are presented. The experimental conditions were chosen to maximise the chances of finding differences in frequency sensitivity between the two word classes (speeded responses and stimulus masking). Both experiments revealed strong frequency effects for open- and closed-class items and thus no asymmetry in frequency sensitivity. The implications of these results for both normal and aphasic populations are discussed.     

Decompressive craniectomy and brain death prevalence and mortality: 8-year retrospective review

Decompressive craniectomy (DC) is a surgical practice that has been used since the late 19th century. The cerebral blood flow increase after the performance of a DC can delay and even prevent the development of cerebral circulatory arrest and brain death (BD). We aimed to determine the prevalence of BD, the use of DC, and the evolution to BD with versus without DC. This retrospective, observational, cross-sectional study was performed in a single high-intensity center in Argentina from January 2003 to December 2010. Inclusion criteria were all patients with Glasgow Coma Score of at most 7 on admission or during their stay in the intensive care units. Exclusion criteria were patients with incomplete data. In cases of death, we assessed whether they fulfilled BD criteria or if the cause of death was a cardiac arrest (CA). The 698 patients considered for analysis showed a 60% (n = 418) global mortality rate. The causes were: CA (n = 270); BD (n = 108) and others considered to be "undefined," namely not assessed completely for the diagnosis of BD (n = 40). According to diagnosis category, traumatic brain injury (TBI) was largest (nearly 50%). The DC group (n = 206) showed significant differences regarding sex and diagnosis category versus no DC group. Mortality was significantly lower in this group (48% versus 65%, P < .001). No significant differences were observed comparing causes of death (CA, BD, or undefined). The use of DC did not influence the frequency of BD development (24% versus 26%, P = .72). The average DC rate was 30% and of BD 16%. The prevalence of DC and better survival were recorded compared with subjects without DC. The prevalence of BD was lower than expected in accordance with national registries; however, among our group, DC did not seem to modify the evolution to BD.